Applicator for surgical clamps



Jan. 17, 1961 .1. F. SKOLD APPLICATOR FOR SURGICAL CLAMPS 5 Sheets-Sheet I Filed Sept. 25, 1958 luvau-roe JOHN F.

KO LD Jan. 17, 1961 J. F. SKOLD APPLICATOR FOR SURGICAL CLAMPS 3 Sheets-Sheet 2 Filed Sept. 25, 1958 INVENTOR Jan. 17, 1961 J. F. SKOLD APPLICATOR FOR SURGICAL CLAMPS 5 Sheets-Sheet 3 Filed Sept. 25, 1958 QQN AT rv.

United States P ten APPLICATOR FOR SURGICAL CLAMPS John F. Skold, 4700 N. Oak Park Ave., Chicago, Ill.

Filed Sept. 25, 1958, Ser. No. 763,402

17 Claims. (Cl. 149.1)

The present invention relates to a novel form of surgical clamp designed for use during the course ofsurgery and adapted to be applied to a vein, artery or other blood ,vessel, either directly or in combination with surrounding anatomical tissue, to constrict the same in a localized region thereof in such a manner that, after the clamp has been effectively applied to the vessel, the latter may be severed in the vicinity of the clamp on the vessel to prevent issue of blood therefrom. The invention further relates to a novel surgical instrument in the formof a clamp applicator by means of which the surgical clamp ofthe present invention may efiectively be applied to a blood vessel, tissue or a combination thereof with a minimum of efiort and without in any way taxing the skill of the surgeon.

Insofar as the surgical clamp of the present invention is concerned, the constriction of blood vessels during the course of surgery for the purposes briefly outlined above, has involved the use of surgical thread, frequently necessitating considerable skill on the part of the surgeon and, in any event, involving prolonged manual operations and the use of both hands, as well as, in many instances, professional assistance. Due to the fact that the severing of a blood vessel usually requires that the severed vessel be twice constricted, once on each side of the region of severance, the performance of each severing operation must be preceded by manual preparatory procedures which greatly lengthen the operating time. The surgical clamp of the present invention is designed to overcome the above-noted limitations that are invariably attendant upon surgery involvingthe severing of blood vessels and toward this end it contemplates the provision of a novel metallic clamping element capable of being deformed by contracting the same about the blood vessel and which, when so deformed or contracted and the deforming force or pressure relieved, will retain its shape and maintain the vessel constricted at the region of application of the clamp with a view toward leaving the clamp imposition on the vessel permanently, although in certain instances it may be desired toremove the clamp after it hasv performed its intended purpose. It is contemplated that the surgical clamp be formed of a material-which is durable in that it will last indefinitely, is not subject to deterioration due to corrosion or to attack by body acids, and which, in its environment within the 'body, will not set up any galvanic action or otherwisev be subject to electrolysis. The clamp also is possessed ofsurface smoothness, offers a low coeflicient of friction to-thesurrounding body tissues, is devoid of sharpprotuberances so that it may conveniently be applied with a minimum of resistance to deformation thereof during application, and thereafter borne by the patient with a minimum of irritation and with maximum comfort.

Insofar as the surgical instrument orapplicator by means of which the clamp is applied to the blood vessel is concerned, it is an important object of. the invention to provide an instrument of the magazine type capable of normally holding a sufficient number of the surgical Patentedw Jan. 17, 1961 clamps to accommodate the vessel restricting requirements of most major operations and of releasing the clamps, one at a time, successively as required for application purposes.

Another important object of the invention is to provide an instrument of this type wherein each surgical clamp, after being released from the magazine containing the clamps, is deposited in an open condition, properly oriented in the instrument for ready and facile applicationflto a blood vessel, in a pair of compression jaws at the extreme forward end of the instrument so that it is necessary merely manually to direct the instrument bodily to a position wherein the open clamp, still retained within the jaws, is brought into operative register with the blood vessel at the desired region of construction, after which the instrument may bejmanipulated by a finger action to close the compression jaws upon the clamp and compress the latter around the blood vessels.

A similar and related object of the invention is to provide such'a surgical instrument in which the trigger action employed for actuating the clamping jaws of the instrument is automatically operable to move the jaws initially from their fully open positions with a relatively slight degree of'force and thereafter, as the jaws approach their fully closed positions, to effect movement thereof with a materially increased degree of force so that as the surgical clamp undergoing compression and consequent distortion will engage the blood vessel to perform its constricting operation, the resistance thereof. to compression may effectively be overcome, while at the'same time the reaction forces exerted on the clamping jaws' will be transmitted to the trigger element so that the'surgeon by his sense of feel may be guided in his various operative movements and. manipulations of the instrument.

Another object of the invention is to provide a surgical instrument of this character which is of the simulated gun type having a barrel section, a grip section and a trigger section and wherein the finger-initiated trigger operation necessary to effect closing of the compression jaws is'of such'character that no jerking or other movements. are imparted to-the grip section tending to move the same from. its exact proper position of orientation relative to the vessel which is being treated. V

A still further and important object of'the invention is to provide a magazine'gun type instrument of the character briefly outlined above which is capable of being assembled and dismantled-with ease and rapidity without requiring the use of any tools. whatsoever and without requiring any special skill whereby the instrument may be dismantled after each use thereof, the various component parts thereof sterilized, and the instrument reassembled for subsequent use by unskilled persons such as nurses, doctors assistants and other hospital personnel.

Yet another object of the invention, in an instrument of this sort, is to provide a magazine-type clamp application in which the magazine associatedtherewith cannot be replenished when devoid of clampsiwithout completely dismantling the component parts: of the instrument. By suchan arrangemengthere will be little tendency for incomplete sterilization of the instrument such as might take place when the. assembled instrument is deposited bodily in the sterilization cabinet in an unauthorized manner.

Another object of the invention is to provide a surgical clamp applicator in which all of the component parts thereof are formed of stainless steel and which therefore is capable of being easily cleaned and sterilized.

Still another object of the invention is to provide a surgical clamp applicator which, as outlined above, is capable of ease and rapidity of assembly, yet in which provision is'made for safeguarding against improper assembly by the interpositioning of similar parts having different functions.

The provision of a surgical instrument in the form of a clamp applicator in which the principal parts thereof may be formed of light sheet metal stampings and which therefore may be manufactured at a relatively low cost; one which is rugged and durable and which therefore will withstand rough usage; one which is comprised of a minimum number of moving parts and which therefore is unlikely to get out of order; one which the constituent parts thereof, in the main, present a smooth exterior and are devoid of cracks and crevices so that the parts may be easily cleaned; one which is smooth and silent in its operation; one which requires no lubrication; one which is attractive in its appearance and pleasing in its design, and one which, otherwise, is well adapted to perform the services required of it, are further desirable features which have been borne in mind in the production and development of the present invention.

Other objects and advantages of the invention, not at this time enumerated, will become more readily apparent as the following description ensues.

In the accompanying three sheets of drawings forming a part of this specification, a preferred embodiment of the invention has been shown.

In these drawings:

Fig. 1 is a side elevational view of a surgical clamp applicator constructed in accordance with the principles of the present invention;

Fig. 2 is a top plan view of the applicator;

Fig. 3 is a sectional view taken substantially along the "11118 3-3 of Fig. 2 in the direction indicated by the arrows and with certain parts broken away to more clearly reveal the nature of the invention;

Fig. 4 is a sectional view similar to Fig. 3 with the clamping jaw replaced;

Fig. 5 is a sectional view taken substantially along the line 5-5 of Fig. 3;

Fig. 5a is a sectional view taken substantially along the line 5a5a of Fig. 5;

Fig. 6 is a fragmentary sectional view taken substantially centrally and vertically through a limited front end region of the applicator magazine and showing the clamping jaws proper on their operative clamp-deforming positrons with one of the surgical clamps compressed therebetween to constrict a blood vessel;

Fig. 7 is a diminutive view of the surgical clamp applicator showing the same in an operative position of use;

Fig. 8 is a sectional view similar to Fig. 5 with one of the clamping jaw elements, a pusher plate and one of the magazine side walls removed to show the interior of the clamp retaining magazine in its loaded condition;

Fig. 8a is an end elevational view of the barrel portion of the surgical instrument;

Fig. 9 is a sectional view similar to Fig. 8 with the magazine side wall and pusher plate replaced;

Fig. 9a is a perspective view of a surgical clamp showing the same in its free or open position;

Fig. 9b is a fragmentary perspective view of a blood vessel, together with the surrounding tissue, showing the clamp of Fig. 9a operatively applied thereto;

Fig. 10 is a sectional view taken substantially along the line 1010 of Fig. 5;

Fig. 11 is an enlarged fragmentary detail sectional view of the front end region of the structure shown in Fig. 10 with the pusher plate in its retracted position;

Fig. 12 is a sectional view similar to Fig. 11 showing the pusher plate partially advanced and in contact with a latch member employed in connection with the present invention;

Fig. 13 is a sectional view similar to Figs. 11 and 12 showing the pusher plate in its advanced position and in the act of transferring the foremost clamp in the magazine to the clamping jaws proper;

Fig. 14 is an enlarged sectional view taken substantially along the line 1414 of Fig. 5;

Fig. 15 is an enlarged sectional view taken substantially along the line 1515 of Fig. 5;

Fig. 16 is a sectional view taken substantially along the line 1616 of Fig. 5; and

Fig. 17 is an enlarged sectional view taken substantially along the line 17-17 of Fig. 8.

In all of the above described views similar characters of reference are employed to designate similar parts throughout.

Referring now to the drawings in detail and in particular to Figs. 1 and 7, briefly, the surgical clamp applicator of the present invention is in the form of a gun-type instrument in which all of the principal parts thereof are formed of stainless steel so that there will be no corrosion thereof after contact with moisture. As will appear presently, the component parts of the applicator are capable of ease of assembly and disassembly without the use of tools and without requiring any particular degree of skill so that, after use, the applicator may be taken apart and the various component elements thereof sterilized prior to the next use thereof, such operations being well within the capabilities of operating room personnel, as well as unskilled hospital personnel. As will also appear presently magazine loading operations wherein the clamp applicator is supplied with surgical clamps requires that the applicator be disassembled so that there will be no inclination for repeated use of the applicator on different patients without in-between cleaning and sterilization operations. The clamp applicator involves in its general organization a simulated gun barrel section 10 of appre ciable length and which is generally square in transverse cross section, a grip section 12 including a handle proper 14 and a trigger element 16 hingedly secured to the handle 14. The barrel section 10 has associated therewith means defining a magazine 18 (Fig. 14) adapted to contain a series of surgical clamps 20, the latter being in the form of generally U-shaped, deformable, stainless steel wire devices adapted to be collapsed about a vein, artery, or other anatomical tube or vessel as shown in Fig. 7 preparatory to severing the same during the course of surgery. At the extreme forward end of the barrel section 10, a pair of opposed movable clamp-retaining and constricting jaws 22 are adapted to successively receive the clamps 20 issuing from the forward end of the magazine and to temporarily retain the same in their open condition wherein they are conveniently accessible for application to the blood vessel by the simple expedient of properly aiming and applying the gun-type applicator to the vessel preparatory to actuating the jaws under the control of the trigger element 16 to collapse the clamp around the blood vessel and thus constrict the latter to block off the flow of blood therethrough. To avoid binding, the surgical clamps 20 are loosely contained in serially arranged fashion within the magazine and are slidable therealong to positions wherein the foremost clamp in the magazine will cooperate with certain feeding mechanism whereby the clamp is projected from the magazine into a position of retention by the jaw assembly, the clamps moving to such positions under the influence of gravity when the barrel section 10 is maintained at such inclination as to overcome the frictional resistance offered by the magazine walls to forward sliding motion of the clamps. A weight 23 is slidably disposed in the magazine 18 rearwardly of the series of clamps 20 and enhances the gravitational effect on the clamps. After the foremost clamp has been ejected from the magazine into its position of retention by the clamping jaws, the instrument may then be brought to any desired position of orientation which may be encountered during normal surgery, the clamp brought into juxtaposition with the blood vessel, and the instrument manipulated for clamping purposes, all in a manner that will be described in considerable detail presently.

:asesmm Referring now specifically to: FigsIl to inclusive, the barrel section It) involves in'its general organization an elongated, open-ended, tubular, outercasing 24 (see also Fig. 15) which is generallyrectangular in transverse-cross section. The casing 24 may be'of integral construction but for convenience of manufacture it is made intwo sections including an UPPCISECtl OIIZGiaHd a lower section 28 each section being U'-shapein. transverse cross section, with the two sections being,telescopically=interfitted and spot welded together at appropriateregions therealong and therearound. The resultant assembled casing structure thus provides top andbottom walls 30 and 32 and side walls 34 and-'36 respectively. The: casing 24 surrounds the magazine 18, as well as thelclam'pifeeding instrumentalities and it also surrounds andatdeast partially houses the jaw actuating instrumentalities. The casing is capable of limited-sliding movement or reciprocation in opposite directions, longitudinally of the-barrel section relative to the magazine-forming frameworkin a manner that will become clear presently to effect successive clamp feeding operations.

Still referring to Figs. 1 to 5 inclusive and particularly to Fig. 15, the barrel section 10 of the instrument further includes a main frame member 40 which has generally the cross sectional shape of an I-beam composed of generally fiat top and bottom plates 50 and 52 respectively permanently secured to the horizontal top and bottom flanges respectively of a channel-shaped member54' by spot welding. The two plates and channel memberhave.

been cross sectioned together in- Figs. 14 and to illustrate the contour of the I-beam construction.

The web portion 49 of the frame member 40 constitutes one vertical side wall of the magazine 18 and the other side wall exists by virtue of a channel member 56 which is nested between the top plate 50 and the bottom plate 52 of the main frame member 40, the channel member 5 6 having a web portion which constitutes one vertical wall of the magazine 18. In order to maintain the web portion of the main frame member 40 spaced from the web portion of the channel member 56 and thus define the magazine 18, interfitting lugs and recesses 64 and 66 are provided on the channel member 54 and in the top and bottom plates 58 and 52 of the main frame member 40. Thus, when the channel member 54 is positioned within the I-beam frame member 40, the web portions of the frame member 40 and the channel member 56 become slightly spaced from each other to define the narrow magazine which, as best seen in Fig. 15, is only slightly Wider than the thickness of one of the U-shaped clamps 22.

A pivot pin 70 projects outwardly from a medial point on the web 49 and a similar pivot pin 72 projects outwardly from a medial point on the channel member 56, the two pins extending outwardly of the magazine 18 in opposite directions and in axial alignment. The pins 70 and 72 may be in the form of small short cylindrical rods or studs which are butt welded to the respective faces of the webs. These pivot pins 70 and 72 constitute fulcrum points for a pair of jaw levers 74 and 76 respectively associated with the pair of jaws 22 and the nature of which will be set forth in detail subsequently.

Magazine feeding operations whereby the surgical clamps 28 are successively fed to the jaws 22 take place under the control of two principal elements, namely a retainer plate or gate bar 80 and a pusher member or bar 82, the two members being disposed on opposite sides of the magazine 18 exteriorly of the same. The gate bar 80 is in the form of an elongated substantially flat strip of resilient stainless steel stock (see also Fig. 3) having a hole 84 extending therethrough which surrounds the pivot pin 70 and having a second hole 86 therein which surrounds a short stud 89 provided on the Web 49, the two holes 84, 86, the pin 70 and the stud 88 serving to fix the gate bar 80 in a true axial position within the barrel sectionnltland prevencaxials shifting thereof along the 'barrel, and: also serving to prevent improper placement 'of the pusher member on the wrong. side of the magazine during; assembly of the parts. Formed onthe forward e'ndzofthe; gate bar is a gate element proper 88 in the form'of awsmall V-shaped enlargement and the extreme =for ward: e nd of the gate bar 80 is recessed as at90 to ac- 'commodatethe concavity of-the forward side of the gate element 88. The gate bar'80, whenin position over the -stud 89-and :pin 70, is adapted to lie fiat against the outside face of the web 49 with the V-shaped gate element 88 projecting through a conformably shaped V-shaped slot 92 formed in the web 49 ofthe' I-beam structure near the -forwardend of the latter. As best shown in Fig. 14, the -V-shaped'gate element 88 operates injthe manner of a detent and projects throughth'eslot192 andextends transversely acrossthe magazine 18' withits convex side facing rearwardly, thus blocking the mouth or discharge opening; ofjthe magazine through which thelcla'mps 20 are discharged and-delivered to the clamping jawsw22.

As: previously stated, the gate bar member 80 is formed of resilient material and thus, due to the inherent resil- ;iency-thereof,;the gate detent 88 is yieldingly maintained in-a blocking-position across the mouth of the magazine 1 8. This ;gate detent normally prevents passage of the foremost clamp 20 from the forward end of the magazine :18, but it is adapted to be forced out of the path of the clamp-and.r'etracted through the V-shaped slot 92 under the influence of the pusher bar 82 in a manner that will ;,now be described explicitly.

The pusher bar 82 is likewise in the form'of a substantially flat strip of stainless steel stock (Fig. 9) which is positionedagainst and is adapted to slide along the outside face of the web portion 62 of the channel member 56. To limit the extent of sliding movement of the pusher bar 82, a slot 94 is formed centrally of the bar and receives therein the pivotpin 72. Formed on the forward end of the pusher bar 82 is a generally V-shaped protuberance or element proper 96 presenting a blunt forward edge 98 having a concavity shaped conformably to the convexity of the rear side of one of the surgical clamps 20 (see also Fig. 9), and a sharp tapered convex rear surface 100 at its rear end (Fig. 13). The edge 98 is designed for'engagement with the foremost clamp 20 in the magazine 18 at the time the clamp is ejected from the magazine. The surface 108 constitutes a cam surface by means of which the pusher element or detent iscau'sed to ride outwardly on the rear edge of a slot 102 provided in the front edge of the web 62 as shown in Fig. 11 during retraction of the pusher bar 82.

The pusher bar 82 is movable between a retracted'position which it approaches in Fig. 11 and wherein the extreme left hand end of the slot 94 (Fig. 9) engages the pin 72, to the advanced position wherein it is shown in Fig. 13 wherein the foremost clamp 20 in the series of clamps in the magazine 18 is engaged by the edge 98 and forced forwardly into position within the jaws 22. During such forward movement of the clamp 20, the gate detent 88 is forced laterally through the V-shaped slot, 92 in the web 49 by a cooperating camming engagement between the clamp and detent as shown in Fig. l2'so that this detent 88 will permit the clamp to be passed from the magazine 18 to the jaws 22. In its retracted position, the pusher bar 82 is flexed as shown in Fig. 11 while in its advanced position it lies substantially flat against the outside face of the. web of the channel member 56. As clearly shown in Figs. 11 and 13, in moving from its retracted position to its advanced position, the pusher element 96 moves longitudinally along the outer face of the web and is maintained in sliding contact therewith under the influence of the inherent resiliency of the material of the pusher bar 82. As the pusher element 96 moves into transverse register with the slots 102 and 92, the element 96 will ride inwardly on the edge of theslot 102 as seen in Fig. 1 1 and move into position behind the foremost clamp 20 in the magazine 18 as shown in Fig. 12, while at the same time it will engage the gate detent 88 and displace the same so that the latter will move transversely and be retracted through the V-shaped slot 92 in the web 49 of the I-beam 40. As the pusher bar 82 continues to move forwardly, the clamp 20 will ride over the detent 88 and be received between the opposed jaws 22, these jaws remaining open to receive the clamp in a manner that will appear presently.

The previously mentioned jaws 22 at the extreme forward end of the barrel section 10 of the surgical instrument are comprised of opposed upper and lower jaw elements proper 104 and 106 respectively, the jaw element 104 being integrally formed at the forward end of the jaw lever 76 and the jaw element being integrally formed at the forward end of the jaw lever 74. The jaw levers 76 and 74 are in the form of elongated stainless steel bars formed of relatively thick stock so that these members are rigid. The jaw member 76 is formed with a medial opening 112 therethrough which receives the pin 72 (Fig. while the jaw member 74 is formed with a medial opening 114 therethrough which receives the pin 70 (Fig. 4). The two jaw levers 76 and 74 are thus mounted for limited pivotal swinging movement in respective vertical planes on opposite sides of the magazine 18 with the jaw member 76 being disposed flat against the outside face of the gate member 80 and with the jaw lever 74 being disposed flat against the outside surface of the pusher bar 82 as best seen in Fig. 14. The forward underneath edge region 116 and the rearward upper edge region 118 (Fig. 5) of the jaw lever 76 are inclined or biased inwardly toward the longitudinal axis of the lever to afford clearance regions whereby the lever may be rocked throughout a limited extent between its extreme jaw opening and jaw closing positions. Similarly, as shown in Fig. 4, the forward upper and rearward lower edge regions 120 and 122 respectively of the jaw lever 74 are inclined or biased inwardly toward the longitudinal axis of the lever for clearance purposes. 'As shown in Figs. to 13 inclusive, the forward end regions of the jaw levers 76 and 74 are recessed on the inside faces thereof as at 124 and 126 respectively to afford clearance regions which will permit flexing of the pusher bar 82 as shown in Fig. 11 and of the gate member 80 as shown in Fig. 12.

The jaw lever 76 is normally urged in a clockwise direction as viewed in Fig. 5 for swinging movement about the axis of the pivot pin 72 by means of a spring 130, one end of which is anchored in a groove 132 provided in the lever and the other end of which bears as at 134 against the top flange 44 of the I-beam frame member 40. In the extreme position of the jaw lever 76, which it assumes under the influence of the spring 130, the jaw element 104 carried thereby will assume its fully open elevated position. As shown in Fig. 4, a spring 136 similar to the spring 130 is anchored in a groove 138 provided in the jaw lever 74 and bears as at 146 against the lower I-beam flange 46 and normally urges the lever 74 in a clockwise direction as viewed in Fig. 4 wherein the jaw 106 carried thereby assumes its fully open or lowermost position.

The jaw assembly 22 which consists of the upper and lower jaws 104 and 106 respectively projects forwardly of the frame member 40 and, as shown in Figs. 6 and 8a, the upper jaw element 104 exists by virtue of a laterally turned portion on the jaw lever 76 which is offset slightly upwardly from the upper edge of this member. Similarly the lower jaw element 106 exists by virtue of a laterally turned portion at the forward end of the lower edge of the jaw lever 74. The opposed faces of the jaw elements 104 and 106 are provided with undercut grooves 142 adapted to receive therein the diverging arms of the various wire surgical clamps 20 so that these clamps may be operatively held in their extended position between the two jaws preparatory to being applied to a blood vessel during surgery. As shown in Fig. 90, each clamp 20 is generally V-shape in configuration and consists of a length of stainless steel wire stock bent to such shape, the material of the stock being readily deformable and possessing no appreciable degree of resiliency so that after it has been deformed and the deforming pressure released, the material will retain the shape to which it has been deformed with no tendency to spring back to its original shape. The clamp 20 includes parallel diverging arms 21 and 23 respectively which are joined together at a relatively sharp apex region 25. The distal ends of the arms 21 and 23 are turned inwardly as at 27 to provide reentrant portions of small extent. The clamps 20 are made with precision accuracy and within very fine limits of tolerance so that after a given clamp has been ejected from the magazine by the pusher bar 82 it will be engaged between the two opposed grooves 142 and make sutficient frictional contact with the walls of the grooves that it will not easily become dislodged therefrom, while at the same time the extent of such frictional contact will not be so great as to appreciably distort the clamp until such time as the jaws are volitionally actuated toward their closed positions to collapse the clamp upon a blood vessel during surgery in the manner indicated in Fig. 9/). When the jaws 22 are thus actuated and brought to their closed positions, the reentrant portions 27 of the clamp 20 will be forced past each other as shown in Fig 9b and the blood vessel constricted by its contact with the inside opposed spaces of the collapsed arms.

The manner in which the pusher bar 82 is reciprocated for successive clamp discharging purposes is best illustrated in Figs. 1, 2, 5 and 9 wherein the rear ends of the pusher bar 82, at the upper edge thereof, carries a plate 150 (see also Fig. 16) having a laterally turned flange 152 which is slotted as at 154 for reception therein of a tongue 156 provided on a leaf spring 157 which overlies the top wall 30 of the rectangular outer casing 24 and which may be spot welded thereto in the rear regions thereof. Normally the leaf spring 157 lies fiat on the top wall 30 with the tongue 156 projecting through a transverse slot 158 and extending into the slot 154 provided in the flange 152. A clearance slot 160 is provided in the upper regions of the frame member 40 to afford freedom of movement of the flange 152 as the pusher bar 82 is slid longitudinally in either direction along the barrel section 10. As previously stated, the casing 24 is slidable bodily and longitudinally in opposite directions on the frame member 40 and, in so moving, the pusher bar 82, through the medium of the tongue and slot connection 156, 154, is reciprocated bodily with the casing 24. A pair of ears 162 projects laterally from the side edges of the spring 157 and constitutes lifter elements whereby the spring 158 may be flexed upwardly to release the slotted fork-like flange 152 for purposes of assembling and disassembling the instrument in a manner that will be made clear subsequently. In Fig. 11 the outer casing 24 is shown as being in its retracted position wherein the pusher bar 82 is retracted. In Fig. 9 the casing 24 is shown as being in its advanced position wherein the pusher bar 82 is advanced. In so moving from its fully retracted position to its fully advanced position under the influence of the impelling action of the outer slidable casing 24 as set forth above, the protuberance 96 on the pusher bar 82 moves forwardly and enters behind the foremost clamp in the magazine so as to force the latter into position between the clamping jaws. It is to be noted that each jaw element 104 and 106 is formed with a short inclined cam surface or edge designed for engagement with the forward open rectangular rim of the outer casing 24 when the latter approaches its extreme forward position. These cam surfaces, upon being engaged by the rim of the casing 24, cause the jaws 22 to be moved slightly inwardly toward their closed position, thus decreasing the effective distance between these jaws so that a clamp 20, upon being pushed forwardly by the pusher bar 82, will be frictionally engaged in the grooves 142 of the jaws and thus prevented from being ejected beyond the confines of the jaws. At this point the instrument is conditioned for operative application of the clamp to the blood vessel, tissue or other anatomical structure to which the clamp is to be applied.

Referring now to Figs. 5 and 5a, '8 and 9 wherein the trigger-actuated mechanism for the jaw levers 108 and 110 is best illustrated, a short channel section 170 is welded ,in' position between the upper and lower plates 50 and 52 of the frame member 40 at the rear end of the latter and the web portion of this channel member 170, in combinationwith the web portion 49 of the frame member 40,. define a narrow rectangular space 172 which constitutes .a rearward extension of the magazine 18. A U-shaped bracket 174 has its base portionwelded. to the channel member 17% and is provided with a pair of, depending spaced sides which receive therebetween the upper end of a handle proper 178. A bolt and nut 1 assembly 180, both ends of which are slotted, passes through the bracket 174 and upper portion of the handle 178 and fixedly secured the handle in position relative to the frame member 40. The upper region of the handle 178 is slotted as at 182 (Fig. 17) and the slot 182 receives therein a flat web portion 184 of a trigger element proper 186. A cross pin 188 provides a fulcrum axis for the swinging movements of the trigger element 186. As best seen in Fig. 8, the web part 184 of the trigger element 186 is provided with a notch 190 which receives therein a pin 192 which extends across a slot 194 provided in a slidable actuator 196 which straddles both the frame 40 and its channel insert 170. A slot 198 (Fig. 5) is formed. in the web portion of the channel member 170 and affords a clearance for the longitudinal movements of the pin 192 so that the actuator 196 may be moved between the full line retracted position shown in Fig. 5 wherein the jaw members M4 and 106 are open, and the advanced dotted line position thereof wherein the jaw members 104 and 106 are closed.

The slidable actuator 196 is normally maintained in its fully retracted position by means of a flat sinuous stainless steel spring 191 which is disposed within the magazine extension 172 and which bears at one end against the forward edge 193 of the trigger web 184 and at its forward end against one edge of a plate 195 (Fig. 8) which is fixedly secured within the rear end of the magazine in any suitable manner as, for example, by welding to the inside face of the web 49 of the I-beam or frame member 40. It will be seen therefore that upon squeezing of the handle and trigger sections 14 and 16 respectively of the instrument to move the trigger proper 186 toward the handle proper 173, the web portion 184 of the trigger will be rocked about the axis of the cross pin 183 and the cross pin 192, will be engaged by the side of the slot 190 and moved forwardly to close the jaws 22 in a manner that will be described presently.

Referring now to Figs. 4, 5 and 5a, one leg 200 of the bifurcated slidable actuator 196 is designed for cooperation with the rear end of the jaw lever 76 while the other end 202 thereof is designed for similar cooperation with the rear end of the jaw lever 74. Accordingly, the forward edge of the leg 200 is provided with a relatively steep inclined portion 204 while the extreme rear end of the jaw lever 76 is provided with a cam incline 208 designed for sliding cooperation with the surfaces 204 and 206. When the actuator 196 is in its fully retracted position, the cam incline 76 on the jaw lever 108 will remain in register with the relatively steep inclined surface 204 and, as the actuator 196 moves forwardly under the control of the trigger element 186, the rear end of the lever 76 will rise upwardly on this inclined surface 204 and thus impart to the upper jaw element 104 a relatively rapid rate of initial closing movement. As the cam incline 204 moves on to the surface 206 the rate of movement of the jaw element 10-4 will be decreased while a more powerful leverage will be exerted on the clamp tending to move the same to its final or 10 home positionagainst one sideofrthe blood-rvessel'undergoing constriction. The forward edge of; the leg; 202101? the actuator 196 is provided with a relatively steep :forwardly and upwardly inclined-cam surface 210 and with .a. relatively gradualcam incline 212 while the extreme .themagazine 18-to containa supply of surgical clamps 20, and-assuming the jaws 922 to; be empty, in order to cause the foremostclamp in the magazine to be shifted bodily from the magazine and positioned'between the open jaws 22, it is merely necessary for the operator to shift the outer casing 24 forwardly along the barrel section 10 of the instrument. Such forward shifting of the casing 24 will cause the tongue 156 (Fig. 9) of the leaf spring 157 to engage the slot 154 of the pusher bar 82 and cause the pusher bar to be shifted forwardly. Forward movement of the pusher bar 82 will cause the forward edge 98 of the bar to engage the foremost clamp 20 in the magazine and force the same past the gate detent 88 which yields to allow the clamp to pass from the magazine 18 into position between the open jaws 22. The edge of the slot 102 prevents the forward edge 93 of the pusher bar 82 from engaging the clamps which are disposed rearwardly of the foremost clamp and the foremost clamp is not engaged until such time as the edge 98 has passed beyond the slot 102. After the foremost clamp 20 has been lodged between the jaws 22,; the casing 24 is returned to its retracted position, thus retracting the pusher bar 82. With a clamp 20, thus positioned between the jaws 22, the front end of the barrel section 10 of the instrument may be guided intoregister with the vein, tissue or other anatomical structure to be seized by the clamp and, upon actuation of the trigger element proper 186, the actuator 200 will be moved forwardly in the manner previously described to effect. cooperation between the rear end regions of the jaw levers 74 and 76 to slide upon the cam surfaces 210, 212 and 204, 206 respectively and effect rocking movement of the jaw levers 74 and 76 for jaw closing purposes, the surfaces 204 and 210 effecting rapid jaw movement and the surfaces 206 and 212 effecting slow jaw movement as previously described.

Closure of the jaws 22 in the manner set forth above will, of course, cause the clamp 20 to be constricted about the vein, tissue or other anatomical structure and. upon release of the trigger element proper 186, the jaws 22 will open and release the constricted clamp 20 while at the same time the other operative instrumentalities associated with the applicator will be restored to their normal position preparatory to a succeeding clamp constricting operation.

From the above description it is thought that the construction and mode of operation of the herein described surgical applicator instrument will be apparent. It is to I be noted that at this point that after any given period of use of the. instrument, terminating either because all of the clamps 20 within the magazine 18 have been exhausted or because a given surgical operation ha been completed, the instrument may be completely disassembled by manual operations without the use of tools of any description. The instrument is completely devoid of fastening screws or the like which must be removed for disassembly purposes and the entire operation of dismantling or assembling the parts may be carried out efliciently by nurses, orderlies or other mechanically unskilled hospital personnel. To dismantle the apparatus, the laterally extending ears 162 on the spring 157 are manually lifted (see Fig. 16) to remove the tongue 156 from the slot 154 in the fork member to thus release the entire casing 24 from the frame bar 40 so that it may slide forwardly along the barrel section and be removed at the forward end of the latter. The various parts, formerly contained within the casing 24 will then be available for successive removal in any convenient sequence. For example, after removal of the casing 24, the two jaw levers 76 and 74 on opposite sides of the magazine are accessible for immediate removal and, after they have been taken from the structure, the slotted pusher bar 82 may be lifted from its nested position between the flanges of the channel member 56. On the other side of the magazine the gate member 80 may then be removed from the stud 88 and pin 70, after which the channel member 56 may be withdrawn from between the upper and lower plates 50 and 52 respectively of the I-beam or frame member 40. Finally, the follower plate 23 may be removed, thus leaving the I-beam or frame member 40 exposed. It is not deemed necessary to dismantle the handle section 14 or the trigger section 16 for sterilization purposes but these sections may be readily disassembled by unfastening the nut and bolt assembly 180 if desired for purposes of inspection, re placement of parts or repair. The various dismantled parts may be placed in a sterilizer where they may remain until it is desired to reassemble the instrument. Assembly of the instrument may be effected by a substantial reversal of the operations set forth above and consequently a description of this assembly operation is deemed unnecessary.

The invention is not to be limited to the exact arrangement of parts shown in the accompanying drawings or described in this specification as various changes in the details of this construction may be resorted to without departing from the spirit of the invention. For example while the I-beam or frame member 40 has been illustrated herein as being comprised of certain component parts welded together to effect a permanent union between the parts and to render the frame member of integral construction, it will be understood that, if desired, this frame member may be initially formed in one piece by a casting or other operation. Only insofar as the invention has particularly been pointed out in the accompanying claims is the same to be limited.

Having thus described the invention what I claim as new and desire to secure by Letters Patent is:

l. A surgical instrument for constricting anatomical tissue closing thereabout a split wire clamp, said instrument being in the form of a gun having a barrel section, a trigger section and a grip section, said barrel section including an elongated barrel-frame member, a pair of first class jaw levers each pivoted medially of its ends to a medial region of the frame member for swinging movement in a vertical plane about ahorizontal fulcrum axis, a pair of opposed cooperating clamp-collapsing jaws on the forward ends of the levers respectively, said levers being movable between retracted positions wherein said jaws are in open spaced apart relationship and advanced positions wherein said jaws are in closed positions of close proximity to each other, means normally urging said levers toward their retracted positions, means on said frame defining a longitudinally extending guideway, a cam actuator for said jaws slidable in said guideway, cooperating cam surfaces on said cam actuator and the rear end of each of said levers, said cam actuator being movable between a retracted position wherein said cooperating cam surfaces are out of eifective engagement and an advanced position wherein said cooperating cam surfaces are in engagement with one another and said levers are in their advanced positions, a movable fingeractuated trigger proper carried by said trigger section, and means operatively connecting said trigger proper and actuator for translating the movements of the former into corresponding movements of the latter.

2. A surgical instrument as set forth in claim 1 wherein the fulcrum axes for said levers are coaxial.

3. A surgical instrument as set forth in claim 1 wherein each of said jaws is formed with an elongated groove therein, and two grooves being disposed in a common vertical plane and extending longitudinally of the barrel section in any of the positions of which the jaws are capable of assuming, the distance between said grooves in the open positions of the jaws being substantially equal to the overall vertical extent of the split wire clamp whereby, in such open positions, a split clamp interposed between the jaws in engagement with the confining walls of the grooves on opposite sides of the split clamp will be frictionally retained within the jaws so that the clamp may be directed into operative position relative to a blood vessel by manual orientation of the instrument bodily as a whole.

4. A surgical instrument as set forth in claim 1 wherein the actuator, is disposed in the barrel section rearwardly of the jaw levers and, in moving from its retracted to its advanced position, travels forwardly along the barrelframe member.

5. A surgical instrument as set forth in claim 1 wherein each of said jaws is formed with opposed shoulders adapted to straddle the wire stock of the clamp when the clamp is in position between the jaws.

6. A surgical instrument for applying transversely fiat split wire clamps successively to blood vessels and then adjacent tissue during surgery by collapsing the clamps about the blood vessels and tissue, said instrument being in the form of a gun having a barrel section, a trigger section and a grip section, said barrel section including a pair of elongated frame pieces providing spaced walls defining therebetween a narrow magazine adapted to contain a supply of the clamps with the clamps being arranged in a longitudinal row and along which magazine the clamps are slidable, the horizontal width of said magazine being slightly greater than the diameter of the wire stock from which the clamps are formed whereby the clamps are maintained in a common vertical plane within the magazine, a fixed pivot pin on each wall extending horizontally outwardly of the magazine, a pair of first class jaw levers pivoted medially of their ends to said pivot pins respectively and occupying positions on opposite sides of the magazine outside said walls, a pair of opposed cooperating clamp-engaging and collapsing jaws on the forward end of said jaw levers respectively, forwardly of the magazine and in axial alignment and register with the latter, said levers being movable between retracted positions wherein said jaws are in open spaced apart relationship and advanced positions wherein the jaws are in closed positions of close proximity to each other, means normally urging the levers toward their retracted positions, the distance between said jaws when the latter are open being substantially equal to the vertical overall extent of the clamps whereby a clamp positioned between the open jaws may be frictionally retained within the jaws, a movable finger-actuated trigger proper carried by said trigger section, means operatively connecting said trigger proper and levers for actuating the latter under the control of the trigger proper, a flexible resilient pusher bar mounted for longitudinal sliding movement on one of said frame pieces exteriorly of the magazine and having a clamp-engaging protuberance thereon at the forward end thereof, said pusher bar being movable between a rear retracted position and a forward advanced position, said protuberance in the advanced position of the bar being disposed forwardly of the magazine and in register with the same, said protuberance, upon rearward movement of the bar, riding outwardly on the outer face of said one frame piece and out of register with the magazine, said protuberance, upon forward movement of the bar, moving inwardly of the magazine and engaging the foremost clamp therein and serving to force the clamp into position between said jaws.

7. A surgical instrument as set forth in claim 6 wherein said pusher bar is formed with a longitudinally extending slot therein through which slot one of said pivot "pins extends, said latter pivot pin, in combination with the opposite ends of said slot, serving to limit the extent of sliding'movement of the pusher bar and thus determine the advanced and retracted positions of the latter.

8. A surgical instrument as set forth in claim 6 where- 'in said frame pieces are in the form of separable members disposed in contiguity, interengaging means on said frame bars maintaining the same against relative axial shifting while permitting transverse separation thereof, and an open-ended barrel casing encompassing said frame members and pusher bar and serving to maintain the same against transverse separation.

9. A surgical instrument as set forth in claim 6 wherein said frame pieces are in the form of separate members disposed in contiguity, interengaging means on said frame pieces maintaining the same against relative axial shifting movement while permitting transverse separa- .tion thereof, an open-ended barrel casing encompassing said frame members and pusher bar and slidable on the frame members and serving to maintain the latter against transverse separation, and an interengaging driving connection between said barrel casing and pusher bar whereby longitudinal shifting movements of the former will be translated to the latter.

10. A surgical instrument as set forth in claim 9 wherein said interengaging driving connection comprises a tongue and slot connection between the barrel casing and pusher bar.

11. A surgical instrument as set forth in claim 9 wherein said interengaging driving connection comprises a tongue on said barrel casing, a laterally turned flange on said pusher bar overlying said magazine, said tongue being provided with a slot therein into which said tongue extends.

p 12. A surgical instrument for applying split wire clamps successively to anatomical tissue during surgery by collapsing the clamps about the tissue, said instrument comprising a gun having a barrel section, a trigger section and a grip section, said barrel section including a pair of elongated frame pieces providing spaced vertical walls defining a narrow magazine, open at its forward end and adapted to contain a supply of the clamps and along which the clamps are slidable, a fixed pivot pin on each wall extending horizontally outwardly of the magazine, a pair of clamp-engaging first class jaw levers pivoted medially of their ends to said pins respectively and occupying positions on opposite sides of the magazine, a pair of vertically opposed cooperating clamp-engaging jaws on the forward ends of said levers respectively and forwardly of the magazine in axial alignment and register with the latter, said levers being movable between retracted positions wherein the jaws are open and advanced positions wherein the jaws are closed for clamp-collapsing purposes, means normally urging said levers toward their retracted positions, the distance between said jaws when the latter are open being such that a clamp positioned thcrebetween will be frictionally retained within the jaws, a movable fingeractuated trigger carried by said trigger section, means operatively connecting said trigger and jaw levers for moving the latter under the control of the former, a yieldable gate member normally extending into said magazine adjacent the forward end thereof and obstructing the passage of the foremost clamp in the magazine from the forward open end of the magazine, a pusher member longitudinally slidable on one of said frame pieces and movable between retracted and advanced positions respectively, said pusher member in the advanced position thereof being disposed forwardly of and in register with the magazine and being adapted upon rearward movement thereof to ride outwardly on said one frame piece to a position out of register with the magazine, said pusher member, upon forward movement thereof engaging said gate member and deflecting the same out of its clamp-obstructing position and thereafter engaging the foremost clamp in the magazine and forcing the same into operative position between the open clamp-engaging aws.

13. A surgical instrument for applying split wire clamps successively to anatomical tissue during surgery by collapsing the clamps about the tissue, said instrument comprising a gun having a barrel section, a trigger section and a grip section, said barrel section including a pair of elongated frame pieces providing spaced vertical walls defining a narrow magazine, open at its forward end and adapted to contain a supply of the clamps and along which the clamps are slidable, a fixed pivot pin on each wall extending horizontally outwardly of the magazine, a pair of first class jaw levers pivoted medially of their ends to said pins respectively and occupying positions on opposite sides of the magazine, a pair of vertically opposed cooperating clamp-engaging jaws on the forward ends of said levers respectively and forwardly of the magazine in axial alignment and register with the latter, said levers being movable between retracted positions wherein the jaws are open and advanced positions wherein the jaws are closed for clampcollapsing purposes, means normally urging said levers toward their retracted positions, the distance between said jaws when the latter are open being such that a clamp positioned therebetween will be frictionally retained within the jaws, a movable finger-actuated trigger carried by said trigger section, means operatively connecting said trigger and jaw levers for moving the latter under the control of the former, a flexible resilient gate bar disposed between oneof said jaw levers and the adjacent vertical wall and having its forward end projecting into said magazine and in the path of clamps issuing from the maga'zine,there being a hole in the medial region of said gate bar and through which one of said pivot pins projects, a flexible resilient pusher bar slidably disposed between the other jaw lever and the adjacent vertical wall, said pusher bar being movable between a rear retracted position and a forward advanced position, said pusher bar in the forward position thereof having its forward end flexed inwardly of the magazine and in register therewith, said forward end of the pusher bar, upon rearward movement of the latter, riding outwardly on the forward end of the adjacent vertical wall and out of register with the magazine, said forward end of the pusher bar, upon forward movement of the latter, moving inwardly of the magazine and displacing said forward end of the gate bar and engaging the foremost clamp in the magazine and forcing the same into position within said jaws.

14, A surgical instrument as set forth in claim 13 wherein said connecting means for the trigger and jaw levers comprises means on said frame pieces providing a longitudinally extending guideway, a cam actuator slidable in said guideway, and cooperating cam surfaces on said actuator and each of said levers at the rear end of the latter, said actuator being movable between a retracted position wherein said cooperating cam surfaces are out of effective engagement with one another and said levers are in their retracted positions and an advanced position wherein said cooperating cam surfaces are in engagement with one another and said levers are in their advanced positions and means operatively connecting said trigger and actuator.

15. A surgical instrument as set forth in claim 14 wherein said grip section comprises a handle fixedly secured to one of said frame pieces, said trigger being pivotally connected to said handle for swinging movements about a horizontal axis, and a pin and slot connecting between said trigger and actuator.

16. A surgical instrument for applying split wire clamps successively to anatomical tissue during surgery by collapsing the clamps about the tissue, said instrument comprising a gun having a barrel section, a trigger section and a grip section, said barrel section including a pair of elongated frame pieces providing spaced vertical walls defining a narrow magazine, open at its forward end and adapted to contain a supply of the clamps and along which the clamps are slidable, a fixed pivot pin on each wall extending horizontally outwardly of the magazine, a pair of clamp-engaging first class jaw levers pivoted medially of their ends to said pins respectively and occupying positions on opposite sides of the magazine, a pair of vertically opposed cooperating clamp-engaging jaws on the forward ends of said levers respectively and forwardly of the magazine in axial alignment and register with the latter, said levers being movable between retracted positions wherein the jaws are open and advanced positions wherein the jaws are closed for clamp-collapsing purposes, means normally urging said levers toward their retracted positions, the distance between said jaws when the latter are open being such that a clamp positioned therebetween will be frictionally retained within the jaws, a movable finger-actuated trigger carried by said trigger section, means operatively connecting said trigger and jaw levers for moving the latter under the control of the former, a flexible resilient gate bar disposed between one of said jaw levers and the adjacent vertical wall and having its forward end projecting into said magazine and into the path of clamps issuing from the latter, there being a hole in the medial region of said gate bar and through which one of said pivot pins projects, a flexible resilient pusher bar slidably disposed between the other jaw lever and the adjacent vertical wall, said pusher bar being movable between a rear retracted position and a forward advanced position, there being a slot in said pusher bar through which the other pivot pin projects, said latter pivot pin, in combination with the ends of said slot, serving to limit the extent of sliding movement of the pusher bar, said pusher bar in the forward position thereof having its forward end flexed inwardly of the magazine and in register therewith, said forward end of the pusher bar, upon rearward movement of the latter, riding outwardly on the forward end of the adjacent vertical wall and out of register with the magazine, said forward end of the pusher bar, upon forward movement of the latter, moving inwardly of the magazine and displacing the forward end of the gate bar and engaging the foremost clamp in the magazine and forcing the same into position within said jaws.

17, A surgical instrument as set forth in claim 16 wherein said connecting means for the trigger and jaw levers comprises means on said frame pieces defining a longitudinally extending guideway, a cam actuator slidable in said guideway, cooperating cam surfaces on said actuator and each of said levers at the rear end thereof, said actuator being movable between a retracted position wherein said cooperating cam surfaces are out of engagement with one another and said levers are in their retracted positions and an advanced position wherein said cooperating cam surfaces are in engagement with one another and said levers are in their advanced positions, means operatively connecting said trigger and actuator, and a barrel-casing encompassing said frame pieces, levers, gate bar and pusher bar and slidable on said frame pieces, and means releasably connecting said pusher bar and barrel-casing for movement in unison whereby said barrelcasing constitutes an actuator for the pusher bar.

References Cited in the file of this patent UNITED STATES PATENTS 2,123,890 Gossrau July 19, 1938 2,123,891 Gossrau July 19, 1938 2,254,620 Miller Sept. 2, 1941 2,277,139 Niemand Mar. 24, 1942 

